Call Center Policy and Procedure Manual-

Call Center Policy and Procedure Manual-

TriageLogic, LLC Version 5.0

Original: November 2013 Last update: February 1, 2018

Approved by:

CALL CENTER POLICY MANUAL TABLE OF CONTENTS

I.

Non-Clinical Staff (NCS)

A. Qualifications HCC4a ....................................................................................... 4

B. NCS Roles and Responsibilities

1. Answering Service Policy for Incoming Phone Calls HCC4b, HCC18a ......... 4

C. Non Clinical Staff Training

1. Non Clinical Staff Training Policy and Procedure HCC4c............................ 5

D. Non Clinical Staff Supervision .......................................................................... 7

E. Non Clinical Performance Standards

1. Policy for Monitoring Telephone Performance Standards HCC10 HCC 11 ... 7

II. Clinical Staff (CS)

A. Medical Director Oversight HCC2

1. Medical Director Job Description HCC2a .................................................. 8

2. Physician Consultation Policy HCC2a,b ................................................... 10

B. Clinical Staff Qualifications HCC5

1.

Telephone Triage Nurse Job Description HCC5a................................ 11

2.

Clinical Staff Credentialing HCC5a Core 30 a-d ................................ 13

C. Clinical Staff Roles and Responsibilities -HCC9 HCC18a

1. Operational Policy for Triaging Incoming Patient Messages and Returning Patient

Telephone Calls HCC5a, HCC^a, HCClSa ......................................................I8

D. Clinical Staff Training HCC19/HCC20

1.

Clinical Staff Training Policy ............................................................... 19

2.

Procedure for Special Circumstances/High Risk Cases ........................ 23

E. Quality Management Program Core 18, 19, 20, 21, 22 .................................. 26

F. Clinical Staff Performance Standards

1. Operational Procedure for Patient Call Intake HCC13 ........................... 37

III. Call Center Technology A. Software Platform Functions and Capabilities - HCC17,18, 19, 20, 21, 22 38 B. Reporting Tools HCC16.............................................................................. 39 C. Clinical Triage Protocols /Annual Protocol Review Policy- HCC6, HCC7, HCC8 ....40 D. Information Management Core 13 ............................................................ 41 E. Business Continuity Core 14 ...................................................................... 42 F. Information Security Policy Core 15 .......................................................... 45 G. HIPAA Compliance Policy ......................................................................... 49

CALL CENTER POLICY MANUAL

I. Non-Clinical Staff (NCS)

A. Qualifications - HCC4a The answering service is a delegated service and establishes their policies and procedures for hiring and training the non-clinical staff. TriageLogic only contracts with answering services that provide medical answering services as a core business.

B. NCS Roles and responsibilities

This policy/procedure applies to:

Effective Date: 11/13/13

_ Triage Logic _ Phone RN _ PRN

Name of Policy/Procedure: Answering Service Policy for Incoming Phone Calls Policy #: 19

Most Recent Revision Dated: Most Recent Review:

HCC4b HCC18a

1. General summary: Patients/callers access triage services either by calling an assigned telephone number specific to the participating physician's office, or as a call forwarded to our contracted medical answering service. The answering service staff obtains demographic data and a basic "chief complaint" and enters this information into our Triage Logic software system and forwards the callers message to the triage nurse call queue.

2. Procedure: The patient's calls are answered directly by a live medical operator HCC13a or in the event all operators are assisting other callers, the caller will be greeted by a tape recorded announcement. The announcement script informs the caller that they have reached the TriageLogic Call Center and that a medical operator will be available to assist them momentarily. However if the caller feels that their signs/symptoms are life threatening the caller is advised to hang up and dial 911, HCC14a.) or remain on the line and our medical operator will be with the caller shortly. HCC14b The NCS collects and confirms specified demographics from the caller including: first name, last name, DOB, call back number and reason for call. All collected information must be validated with the caller including spelling of names, date of birth, and phone number to ensure accuracy of collected facts. In accordance with HIPAA NCS members are permitted to only collect defined necessary data to complete the operator intake form. HCC18.a

3. The NCS enters the collected data directly into the Triage Logic software website which makes that call immediately available to be reviewed by all the nurses in the call center. HCC4d

4. The NCS member informs the caller that the request has been submitted to the nurse and they can expect a call back in about 30 minutes or less. HCC13c

5. NCS members are not permitted to perform any clinical activities or make any medical decisions. All calls must be put into the system for the nurses. HCC3b The following situations, which are specified by the client in the software used by the NCS, are the only

exceptions.

a. Caller reports no medical symptoms and needs non clinical information such as routine office hours, fax number and location.

b. Practice has specified that any non-clinical situations where caller should be told to call back during office hours such as referrals and appointment scheduling. HCC3b

C. NCS Training

This policy/procedure applies to:

_ Triage Logic _ Phone RN _ PRN

Name of Policy/Procedure: Non Clinical Staff Training Policy and Procedure Policy #: 20

Effective Date: 11/13/13

Most Recent Revision Dated: Most Recent Review:

HCC4c

1. General summary

Customer relations are one of our highest priorities and extended efforts are required to identify and meet patient needs. Focus is placed on providing optimal customer services partnered with exceptional patient care. In order to ensure these priorities are delivered to our patients it is paramount that we provide a detailed, comprehensive, focused training process for our non-clinical staff and medical call center agents. Our training process concentrates on our staff utilizing their individual specialized skills, and developing professional team members. The training time frame depends on the applicant's previous call center or healthcare experience. We expect a similar training process from contracted answering service for medical call center agents. Our training program outline is as follows:

2.Procedure

a. The medical call center agent training begins with the trainee learning about the basics of what makes a successful telephone call. We also focus on call control and the techniques for handling difficult callers

b. The trainer then works one on one with the trainee discussing quality benchmarks and what makes a successful call.

c. Training to orient to medical terminology, call management in the context of patient care, physician practice and healthcare organization protocols. The trainee is also educated about the importance of HIPAA as they may at times be privy to potentially sensitive personal medical information. Staff members are trained to understand the

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